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1. (a) Is the current certificate of worker's compensation insurance on file? YES X NO[] <br /> (b) Does the contractor possess a"Hazardous Substance Removal Certification"? YES K NO[] <br /> (c) Has everyone on site,including crane/backhoe operator, been certified to work on <br /> hazardous waste sites in accordance with CCR Title 8? YES I& NO[] <br /> 2. Has a"Site Health&Safety Plan"for this job site been submitted? YES J( NO[] <br /> 3. Has applicant performing removal in the City of Tracy obtained a"Grading and Excavation Permit"? <br /> N/A,K YES [] NO[] If YES, Permit# <br /> 4. Has the contractor obtained approval from the local fire department to perform tank cutting?NA)KYES[] NO[] <br /> 5. Is there knowledge or evidence of leakage from the tank(s)and/or piping? (If yes, please explain)YES[] NOK <br /> 6. If tank residual exists,identify transporting hazardous waste hauler: <br /> Name 016g-"LOLS PJ4V. d.VG, I IV C . Hauler Registration# 2 97 <br /> Address 06*4T&P- City 1G+4 Zip <br /> Phone#( ) 4'bo. X00 <br /> 7. Decontamination Procedures: <br /> a. Will tank(s)and piping be decontaminated prior to removal? YES [] NO X <br /> b. Identify contractor performing decontamination: <br /> Name fel /A <br /> Address City Zip <br /> Phone No.( ) <br /> C. Describe method to be used for decontamination: <br /> !V /A <br /> d. Describe how rinsate material will be stored onsite prior to manifesting offsite: <br /> tl/A <br /> e. Rinsate Hauler and permitted Treatment, Storage&Disposal Facility: <br /> Hauler Name 6316W ►t t1P=E EwN SNG. IWC-- Hauler Registration#VIMV" �J97 <br /> Address 2�?1 TbW WE C UMT11i City Q }GN Zip eta 4.It=) <br /> Phone No.( V*cP ) 4 t0t:�. S ZOO <br /> Permitted Disposal Site ,L-rw.hrtJ 1��iZ•P�1R"�' Int 1 RCIJM�'7�►l.. <br /> 8. a. Describe the method that will be utilized to purge and/or inert the tank(s): <br /> TIS-{IDIS 1ZI N SE <br /> b. Tank/Piping Hauler: <br /> Name "LOS+1 W-V 0414. W�/C. I NG . <br /> 14=voT=*iLL. <br /> Address �,r.��'71 'MV40,AE 021-- E City 1Z0rtG K Zip <br /> Phone No.(~ ) -4400. SzOG <br /> Hauler Registration#(if hauled as hazardous) Com" Qy0 1$ 1 <br /> EH 23 046 (Revised 07/22/10) 4 <br /> p(p P-o v" <br />